Health New England is an HMO that provides coverage through the plan’s network of doctors, hospitals, and other providers. Members must select a Primary Care Provider (PCP) to manage their care; referrals to network specialists are not required. Members pay lower office visit copays when they see Tier 1 or Tier 2 specialists. Contact the plan to see how your provider is rated.
Contact the plan to see if your doctors and hospitals are in the network. There are no out-of-network benefits, with the exception of emergency care.
! Your Responsibility
Do your doctors and hospitals participate in Health New England?
Contact the Plan.
Plan Contact Information
Contact the plan for additional information on participating providers and benefits.
$250 per individual up to a maximum of $750 per family.
In-Network Out of Pocket Maximum
$5,000 per individual; $10,000 per family
Copays Effective July 1, 2014
Primary Care Provider Office Visit
$20 per visit
Most covered at 100% - no copay
Specialist Physician Office Visit
Health New England tiers the following specialists based on quality and/or cost efficiency: Cardiologists, Endocrinologists, Gastroenterologists, General Surgeons, Obstetricians/Gynecologists, Orthopedists, Otolaryngologists (ENTs), Pulmonologists, and Rheumatologists.
***Tier 1 (excellent): $25 per visit
**Tier 2 (good): $35 per visit
*Tier 3 (standard): $45 per visit
$20 per visit
Outpatient Mental Health and Substance Abuse Care
$20 per visit
Inpatient Hospital Care -Medical (Maximum one copay per person per calendar year quarter; waived if readmitted within 30 days in the same calendar year)
$250 per admission
Outpatient Surgery (Maximum four copays per person per calendar year)
$110 per occurrence
High-Tech Imaging (e.g., MRI, PET and CT scans) (Maximum one copay per day)
$100 per scan
$100 per visit (waived if admitted)
Retail up to 30 day supply: Mail Order up to 90 day supply:
Tier 1: $10 Tier 1: $20
Tier 2: $25 Tier 2: $50
Tier 3: $50 Tier 3: $110
Who is Eligible?
Employees, Retirees, GIC Retired Municipal Teachers (RMTs), Elderly Governmental Retirees (EGRs), Survivors, and their eligible dependents without Medicare are eligible.
Where You Live Determines Which Plan You May Enroll In
Health New England is available in the following Massachusetts counties:
Berkshire, Franklin, Hampden, Hampshire
Health New England is available only in certain parts of the following Massachusetts county; contact the plan to find out if you live in the service area:
Health New England is available only in certain parts of the following state, contact the plan to find out if you live in the service area.
This information provided by the Group Insurance Commission .